Periodontitis and Systemic Health Flashcards
What is an association?
a correlation observed between many variables but causation cannot be determined
What is a causation?
change in one variable will produce a change in another variable
Outline systemic conditions which have been linked to periodontal disease with a strong evidence base
Cardiovascular disease
diabetes
adverse pregnance outcomes
Outline systemic conditions which have been linked to periodontal disease with a weak evidence base
obesity
respiratory disease (COPD, pneumonia)
CKD
Rheumatoid arthritis
cognitive impairment
metabolic syndrome
cancer
What hormones are implicated in vascular changes observed in pregnancy? What are these vascular changes?
progesterone
oestrogen
they cause increased vascular permeability
What is the implication of vascular changes observed in pregnant women on periodontal disease?
increased vascular permeability along with plaque can cause inflammation
What oral health complications are observed during pregnancy ?
pregnancy gingivitis
pregnancy epulis
What is a pregnancy epulis?
severe swelling of the gums
What are the risk factors for pregnancy complications?
- young mothers <18
- genito-urinary infections
- periodontitis
- drug or alcohol abuse
- maternal stress
- genetics
- idiopathics
Give examples of pregnancy complications
- low birth weight <2.5kg
- pre-term birth - birth before 32 weeks
- growth restrictions
- pre-eclampsia - maternal hypertension and proteinuria
- miscarriage or still birth
What pregnancy complications are associated with periodontitis?
- low birth weight
- preterm birth
- pre-eclampsia
Outline the possible mechanism for pregnancy complications due to periodontitis
presence of periodontal bacteria in foetal-placental unit which may initiate an inflammatory response leading to adverse outcomes
What is the management of gingivitis in pregnant women?
OHI and PMPR
What is the management of periodontitis in pregnant women?
OHI and PMPR
What is the management of epulis in pregnant women?
delay plans to excise. May need to do cleaning
Re-evaluate need for surgical option post partum as it may resolve
What is the management of oral surgery in pregnant women?
avoid during pregnancy
delay until delivery
What are the oral complications of diabetes?
- xerostomia
- opportunistic infection
- caries
- delayed wound healing
- oral parasthesia
- susceptibility to perdiodontal disease
- altered taste sensation
What are the disease processes associated with chronic hyperglycaemia?
- retinopathy
- neuropathy
- nephropathy
- micro and macro vascular disease
- impaired wound healing
Diabetics with poor glycaemic control have a _____ fold increased risk of developing periodontitis
three fold increased risk of developing periodontitis
What test can give an indication of long term glycaemic control?
HbA1c
What kinds of periodontitis patients are at a risk of developing diabetes?
those with higher levels of HbA1c
Patients with T2DM with periodontitis are more likely to experience diabetic complications. True or false
true
What factors contribute to the risk of developing periodontitis in diabetic patients?
- PMNL functions
- Collagen metabolism
- Advanced glycation end-products
How is PMNL function affected in diabetes?
- impaired chemotaxis, phagocytosis and adherence
- PMNL defects may be inherited or secondary to hyperglycaemia
How is collagen metabolism affected in patients with diabetes?
diabetics synthesis less collagen
diabetics also have higher levels of PMNL collagenase which breaks down collagen
smoking affects fibroblasts; collagenase also affected in smoking
Outline the impact of AGE products in the pathogenesis of periodontitis in diabetic patients
- in hyperglycaemic environments AGE formation increases
- AGE produces cause collagen cross linking (covalent bonds between collagen and other fibrils)- reducing solubility/turnover of collagen
- reducing solubility/turnover of collagen means that there is impaired wound healing
- monocytes also have receptors for AGE- RAGE (receptors)- when AGE binds to RAGE, release of pro-inflammatory cytokines such as IL-1, IL-6 and TNFa are released
- would healing ( due to compromised collaged solubility and increased collagenase removal of newly formed collagen) compromised
How do you manage periodontitis in diabetic patients?
- advise patient about increased risk of periodontal disease
- collect detailed diabetic history
- review MH
- maintain periodontal health
*advice - tailored OHI
- diet advice
- smoking cessation if applicable
- PMPR as indicated
Briefly outline the association between the glucose metabolism and the changes to the periodontal microbiome
- recent studies show an association with altered glucose metabplism and periodontal microbiomer
- no causal relationship has been developed
Improving control of diabetes can result in improvements in periodontal status. True or false
true
Improving periodontal health can result in the improvement of metabolic control and/or complications of diabetes. True or false
true
Atherosclerotic cardiovascular diseases (ACVDs) include …
- coronary heart disease- MI, angina
- ischaemic cerebrovascular disease- stroke, TIA
- peripheral vascular disease
Periodontitis is a chronic inflammatory condition, if left untreated it can result in…
exarcebation of inflammatory conditions including ACVDs
Outline a plausible mechanism for the periodontal relationship with CVD
- chronic oral infection –> bacteraemia –> host response/inflammation –> athero-thrombotic lesion
There is _______ evidence base that CVD is a risk factor for periodontitis
limited
thought is was strong?
What kind of treatment can induce bacteraemia?
periodontal treatment
CRP is used to measure …
inflammation
good measure for future ACVD as higher levels of CRP are associated with increased risk of cardiovascula events
How should you manage periodontitis with patients who have CVD?
- staged periodontitis treatment
- multiple visitis area advised
- liaise with cardiologist
- patienst with perio and other risk factors such as HTN, smoking or obesity who have not seen their GMP for over a year should book a cardiac review
Why are multiple visits advised for perio patients with CVD?
treatment is associated with transient impairement of endothelial function a week after
What is the recall for periodontal monitoring for patients with CVD with no periodontitis?
regular periodontal monitoring at least every 12 months
Poor diet/nutrition is a _______ variable for the development of periodontitis
confounding
There is currently no proven link between osteoporosis and periodontitis. True or false
true
What is the current evidence for links between rheumatoid arthritis and periodontitis?
some evidence that periodontitis may contribute to pathogenesis of RA however longitudinal study required to clarify association
What is an important factor for the prevention of hospital acquired pneumonia, especially in patients on ventilators?
improved oral hygiene
What are the difficulties with establishing associations/links between CKD and periodontitis
- complex pathogenesis
- links with diabetes and other conditions
Recent meta-analyses consistently show a ________ association between obesity and periodontitis
statisitically significant positive
however few studies included are longitudinal thus overall effect appears to be modest
Why are studies into possible associations between periodontitis and cancer difficult?
- unable to control confounding factors such as smoking and socio-economic status
Periodontitis has been identified as a possible risk factor for what kinds of cancers? (further long- term follow up studies are still needed)
pancreatic cancers
oro-digestive cancers
